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General NPI Number Information
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NPI Number | 1609850494
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Entity Type | Organization
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Legal Business Name | NAVARRO CONVALESCENT, INC.
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 3002 W 2ND AVE
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City | CORSICANA
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State | TX
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Zip | 75110-2408
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Country | US
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Telephone | 903-872-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 3002 W 2ND AVE
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City | CORSICANA
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State | TX
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Zip | 75110-2408
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Country | US
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Telephone | 903-872-5130
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES W MOORE SR.
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Credential |
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Telephone | 409-962-0910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 111240
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License Number State | TX
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